The clinical significance of slightly to moderately increased liver transaminase values in asymptomatic patients

Background: Our aim was to study liver disorders in asymptomatic patients w ith slightly to moderately increased liver transaminase values in a populat ion living in an area with a low prevalence of viral and hereditary liver d iseases. Methods: One hundred and fifty consecutive patients with slightly to moderately increased liver transaminases for at least 6 months without s ymptoms or signs of liver disease were included. Median (range) was 0.75 mu kat/l (0.24-2.9) for aspartate aminotransferase (ASAT) and 1.18 mu kat/l ( 0.28-4.5) for alanine aminotransferase (ALAT). A percutaneous liver biopsy was performed, and blood was sampled for a detailed biochemical and serolog ic profile. Results: Chronic viral hepatitis C was found in 15.3 % of the p atients, autoimmune hepatitis in 1.3 %, primary biliary cirrhosis in 1.3 %, and heterozygotic alpha-l-antitrypsin deficiency in 0.7 %. Presumed alcoho lic liver disease was diagnosed in 8 % , and non-alcoholic steatohepatitis in 2 % . Chronic hepatitis with no obvious etiology was diagnosed in 24 %, of whom 39 % had interface hepatitis (piecemeal activity). Seventy-one per cent of these 39 % had measurable levels of autoantibodies, but IgG levels within normal Limits prevented the 'clinical' diagnosis of autoimmune hepat itis. Liver steatosis was the diagnosis in 40 %. Most were overweight and h ad increased serum triglyceride levels. However, in 13.3 % the fatty infilt ration was considered 'essential', as both body mass index (BMI) and trigly ceride levels were normal. Other diagnoses were liver fibrosis with no obvi ous inflammatory activity (3.3 %), cirrhosis of unknown etiology (0.7 %), a nd for the remaining (3.3 %) patients histopathologic findings were conside red 'normal'. Cirrhosis was found in five biopsy specimens: hepatitis C (n = 2), autoimmune hepatitis (n = 1), primary biliary cirrhosis (n = 1), and cryptogenic cirrhosis (n = 1). No concomitant disease was of importance for the diagnosis and/or histopathologic findings. No obvious drug-related inc reased liver test results were found with any single drug. However, patient s with chronic hepatitis of unknown etiology, especially with interface hep atitis, significantly more often than the rest of the population were recei ving drug treatment. Conclusion: Most transaminitis patients had steatosis, and some had defined diseases including chronic hepatitis C. Chronic hepat itis of unknown etiology was found in a substantial proportion (24 %) of a population living in an area with a low burden of hepatic viruses and genet ic disorders.